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ASU Yr4 Flashcards > Hematology > Flashcards

Hematology Flashcards

1
Q

Anemia

A

Male <13.5g/dl and <41% ht
Females < 12g/dl and <36% ht

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2
Q

Causes of megaloblastic anemia

A

B12 and folate def

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3
Q

Causes of non megoblastic macrocytic anemia

A
  1. Hypothyroidism
  2. Liver disease
  3. Bone marrow myelodysplasia (bone marrow aplasia: normocytic)
  4. Alcohol intake
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4
Q

Parentral iron indications

A
  1. Rapid increase of stores
  2. Toxicity/ noncompliance of oral
  3. Malabsorption
  4. High rate of blood loss
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5
Q

Dose of iron calculation

A

Iron deficit in mg= weight kg x (14-Hgb) x (2.145)+ (500 if need full store)

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6
Q

Eitology of anemia of chrinic disease

A
  1. Impaired iron utilization
  2. Direct inhibition of erthropoisis
  3. Impaired erthrpoiten production
  4. Due to inflammatory cytokines
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7
Q

Causes of aquired sidroplastic anemia

A
  1. Heavy metal poisoning lead and arsenic
  2. Copper and vit B6 def
  3. Zinc overdose
  4. Alcohol abuse
  5. Isoniazid, chloromphenicol, linzolid
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8
Q

B12 dietary note

A

From animal products
Body store 5mg
Daily req 2-5 ug
Def is rare takes years

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9
Q

Folate dietary note

A

Source is widespread
Def is common
Store 5mg
Daily req 50-200ug

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10
Q

Symptoms and signs of B12 def

A

Anemic symptoms and signs plus
1. Neuropsychiatric changes
2. Peripheral neuropathy
3. Subacute combined spinal cord degeneration
4. Fissured sore tongue
5. Memory and vision problems

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11
Q

Hypersegmented neutrophils

A

B12 def

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12
Q

Homecysteine elevated in

A

B12 and folic acid def

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13
Q

Elevated methylmalonic acid in

A

B12 def

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14
Q

Prenicious anemia special tests

A

Anti-intrinsic factor Ab : specific only
Anti-parietal cell Ab: sensitive only

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15
Q

Treatment of B12 def

A

Parenteral:
1mg/ day x 7 days
1mg/week x 4 weeks
1mg/month for life

Oral:
1mg/day for life

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16
Q

Commonest cause of B12/ folate def

A

B12: prenicious anemia
Folate: dietary intake (alcohol&pregnancy)

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17
Q

Spur cell hemolytic anemia

A

Due to advanced liver disease lead to increase in surface area without increase in volume (free cholestrol abnormality) = characterized by thorny surface and acquired nonimmune extravascular hemolysis

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18
Q

PNH

A

C55,59 defect leads to night time hemolysis and thrombosis due to complement attack

Budd-chiari syndrome (venous thrombosis

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19
Q

Hereditary spherocytosis

A

Autosomal dominant
Membrane spectrin/ankyrin abnormality
Spherocytes on blood film
Extravascular hemolysis
Splenomegaly

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20
Q

Sickle cell anemia

A

Autosomal recessive
Beta globin 6 codon
Glu to valine or A to T
Functional splenectomy

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21
Q

Pharmacologic elevation of HbF by

A

Hydroxyurea

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22
Q

Warm hemolytic anemia

A

IgG mediated

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23
Q

Cold hemolytic anemia

A

IgM mediated

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24
Q

Treatment of Autoimmune hemolytic anemia

A

Treat cause
Prednisone. 1mg/kg/day for 2 weeks then taper
Splenectomy
Immunosuppressive agents Rituximab
IVIG

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25
Q

Ppt factors to sickle cell crisis

A

Hypoxia
Acidosis
Dehydration
Fever
Infection
Exposure to cold

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26
Q

Intravascular hemolysis

A

MAHA
Chemical exposure
ABO incompatibility
Infection

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27
Q

DD of MAHA

A

TTP
HUS
DIC
Mechanical valve
Pre-eclampsia and HELLP syndrome of pregnancy
Vasculitis

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28
Q

Cold AIHA notes

A
  1. Cold temp 0-5 degrees
  2. Igm and complement
  3. Intravascular hemolysis and liver sequestration primarily
  4. Positive DAT/Coombs test
  5. Peripheral agglutination
  6. Related to mycoplasma pneumonae, EBV, CMV
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29
Q

Warm AIHA notes

A
  1. IgG mediated At 37degrees
  2. Extravascular hemolysis, spleen primary sequestration site hence spleenomegally
  3. Positive DAT/coombs surface IgG on RBC
  4. Smear shows spherocytosis
  5. Associated with lumphoploriferative ds, collagen ds SLE, drugs like methyldopa
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30
Q

Preservation of blood transfusion components

A

Red cells : 4 degrees for 35 days
FFP: -30 degrees for 36 months after thaw 24hr at 4 degrees
Platelets: 22 degrees for 5 days

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31
Q

F to Celsius conversion

A

((F-32) x5 ) / 9

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32
Q

Genes of ABO and Rh found on!?

A

ABO chromosome 9p
Rh chromosome 1

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33
Q

PRBC volume and ht

A

Volume 180-200ml
Ht: 65-75%

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34
Q

Whats the effect of 1 unit PRBC on Hb and Hct?

A

1 unit raises Hb by 1g/dl and hct by 3%

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35
Q

PRBC threeshold and target

A

Threshold is 7g/dl = 7 units
Hb Target in critical patients is 10g/dl

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36
Q

What is Single donor platelets

A

Jumbo platelets: From one donor; via aphaeresis machine, 200-400ml

1SDP = 6 units of RDP

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37
Q

How is random donor platelts RDP prepared

A

From whole blood by centrifugation. And is about 50-70ml

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38
Q

1 RDP increases platelet counts by?

A

5000-10000 in unsensitized pt without consumption (DIC splenomegaly..

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39
Q

Platelet target in surgeries is

A

50000

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40
Q

Indications of FFP

A
  1. Warfarin reversal
  2. Liver disease
  3. DIC
  4. Congenital bleeding
  5. TTP

Volume : 200-250ml
Dose: 10-15ml/kg

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41
Q

Effect of 1 unit FFP on coagulation factors

A

Raises it by 2%

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42
Q

Contents of cryprecipitate

A

Fibrinogen, vWF, factor 8

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43
Q

Indications of cryopre

A

DIC
FIBRINOGEN < 100mg/dl
Hemophilia A
vWF ds

Volume 10-15ml and 1 unit contain 80units of factor 8

44
Q

Name 4 Early immune complications of transfusion

A
  1. Acute hemolytic TR
  2. Febrile non hemolytic TR
  3. Allergic non Hemolytic TR
  4. Transfusion-related Acute lung injury
45
Q

Name 6 non immune early complications of transfusion

A
  1. Circulatory overload
  2. Hyperkalemia
  3. Bacterial infection
  4. Citrate toxicity
  5. Dilutional coagulopathy
  6. Iron overload
46
Q

Acute hemolytic transfusion reation

A

ABO incompatabiliy IgM mediated
Fever, chills, dysnea, back and flank pain, hypotension, intravascular hemolysis, hemoglobinuria, AKF,

47
Q

Ektiology of acute febrile non hemolytic reaction

A

Donor cytokines attack the patient and patient attack donor’s WBCs and Platelets

Within 6hrs

48
Q

Allergic non hemolytic reaction

A

IgE against donor’s plasma result in histamine release

49
Q

Leading cause of transfusion related morbidity and mortality

A

TRALI
Occurs within 2-6 hrs

50
Q

Managment of allergic acute transfusion reaction

A

If mild (urticaria :common) : slow transfusion rate + diphenhydramine

If modorate to severe: stop transfusion, IV diphenhydramine, steroids, epinephrine, IV Fluids, bronchodilators

51
Q

CXR of TRALI

A

Bilateral interstitial infiltrate

52
Q

When to stop transfusion

A
  1. Acute hemolytic TR
  2. Febrile non hemolytic reaction fever >or equal 39 with severe symptoms
  3. Moderate or severe Allergic non hemolytic reaction
  4. TRALI
  5. Circulatory overload
  6. Bacterial infection
53
Q

Iron chelators

A

Deferoxamine and deferasirox

54
Q

Delayed transfusion hemolytic anemia cause

A

Alloantibodies IgG against minor antigens eg Duffy and kell
Within 3-14 days

55
Q

Transfusion associated Graft vs host disease

A

Transfused T lymphocytes react against host
In 4 to 30 days
Prevented by giving irradiated blood products

56
Q

Gender ratio in bleeding disorders

A

Platelet > in females
Coagulopathy > in males

57
Q

TT test for

A

Thrombin time: fibrinogen abnormality and heparin

58
Q

Normal PT time

A

12-15 sec for extrinsic pathway

59
Q

INR

A

PT of patient /PT of control ( 0.9-1.1)
For warfarin, liver ds, vitamin K status

60
Q

APTT

A

For internsic pathway
25-39 sec
Monitor heparin treatment, antiphospholipid Ab, coagulation factor deficiency

61
Q

Prolongation of both PT and APTT

A
  1. Severe liver disease
  2. Warfarin
  3. Therapeutic fibrinolysis
  4. DIC
  5. Isolated fibrinogen, factors 2,5,10 def
  6. Severe vit K def
62
Q

Lupus anticoagulant

A

Prolongs APTT

63
Q

Normal bleeding time

A

2-8 minutes

64
Q

DD of ITP

A
  1. In vitro platelet clumping due to EDTA
  2. Pregnancy, hypersplenism, viral, drug
  3. TTP, DIC, MDS, Autoimmune as SLE
65
Q

ITP Therapy

A
  1. Glucocorticoids
  2. Rituximab
  3. Splenectomy
  4. Thrombopoitin agonist
  5. Ttt H.pylori

Emergency ttt: glucocorticoids high dose and IVIG

66
Q

Acquired qualitative platelet disorder

A
  1. Uremia
  2. Cirrhosis
  3. Myeloproliferative disorders
  4. Myeloma and related
  5. Cardiopulmonary bypass
  6. Drugs and ethanol
67
Q

Most common congenital bleeding disorder

A

vWF def

68
Q

MM criteria

A

2 out of 3

  1. Plasma cells < 10%
  2. Paraprotiens in blood or urine
  3. Osteolysis
69
Q

Follow up test for MM

A

LDH and B2 microglobin

70
Q

C/P of MM

A

CRAB

Hypercalcemia without ALPase
Renal impairment
Anemia
Bone lesions

71
Q

4T of HIT Types 2

A

Thrombocytopenia (<50%)
Thrombosis (due to platelet clumping)
Timing 5-10days after heparin
Thrombocytopenia (of no other cause)

72
Q

HIT2 eitiology

A

Ab against PF4
Immune mediated need to stop heparin and give another type of anticoagulant not heparin based

73
Q

How to differentiate AML from ALL

A

AML is myeloperoxidase +ve and auer rods
More common in adults

74
Q

Leukomoid reaction

A

TLC not more than 100K/mm3
High NAP score (neutrophil alkaline phosphatase)

75
Q

Good prognostic marker of CML

A

Philadelphia Chromosome (9:22 long arm translocation)

76
Q

Massive spleenomegally in?

A

CML
Myelofibrosis
Stage 3 of hepatic schistosomiasis

77
Q

Relative thrombocytopenia

A

Acute: dehydration
Chronic: HTN and o o obesity

78
Q

Absolute polycythemia

A

True incr in RBC mass
1. Primary JAK2 mutation
2. Secondary: incr EPO or hypoxia

79
Q

DD of Dry BM tap

A
  1. Myelofibrosis (tear drop and massive spleen)
  2. Hairy cell leukemia
80
Q

Pruritis

A
  1. Hodgkin lymphoma LN with alcohol intake
  2. Polycythemia vera after hot bath
  3. Fat embolism (usually rash on chest/back)
81
Q

High ESR

A

TB
Lymphoma
Pyogenic liver abscess

82
Q

DD epitrochlear LN

A
  1. Nonhodgkin
  2. HIV, EBV
  3. CLL
  4. TB, sarcoidosis
  5. Syphillis
83
Q

LDH in lymphoma

A

Is of bad prognosis

84
Q

Definitive diagnosis of lymphoma

A

LN biopsy

85
Q

Low ESR

A

Sickle cell

86
Q

CML genetic abnormality?

A

Philadelphia chromosome t9:22 BCR-ABL

87
Q

Blast crisis of CML

A

When it accelerates and transforms to AML/ ALL

88
Q

How to differntiate between increase RBC due to PV or Chronic hypoxia or RCC

A

By performing ABG and EPO level study

89
Q

What is the genetic mutation in polycythaemia vera?

A

Acquired JAK2 mutation: cytoplasmic

90
Q

C/P of polycythaemia vera

A

Aquigenic pruritis (hot water bath)
hyper-viscosity -> thrombosis such as bud chiari syndrome
Headache
Hypertension
Plethora and flushing

91
Q

Treatment of polycythemia vera

A

Phlebotomy
Hydroxyurea
Ruxolitinab (jak2 inhibitor)

92
Q

What is erythromelalgia

A

Severe burning pain and red blue discolouration due to episodic blood clots in the vessels of extremities And this can be seen with polycythemia vera and essentials thrombocythemia

93
Q

Mention some causes of increased platelet count

A

Essential thrombocythemia
Polycythemia vera
CML
Iron def anemia
Acute bleeding/hemolysis
Infection and inflammation
Metastatic cancer

94
Q

Abnormal finding in myelofibrosis

A

Extensive fibrosis
Dry tap
Tear drop RBCs
Huge spleen
Variable findings of Plt and WBCs

95
Q

Increase abnormal platelets only

A

Essential thrombocythima

96
Q

Pseudo-pelger-hüet anamy

A

CML

97
Q

Toxic granulations and Döhle bodies

A

Neutrophil morphology in Leukamoid reaction

98
Q

What is the cell that leads to the development of myelofibrosis of BM

A

Megalaryoctyes : secrete TGF-B and PDGF

99
Q

Whats the esinophil and basophil levels in leukamoid reaction versus CML

A

Leukamoid: normal
CML: increased

100
Q

Plasma volume is increased/decreased in polycythmia vera

A

Increased

101
Q

T(8:14)

A

Burkitt lymphoma (c-myc activation)

102
Q

t(11,14)

A

Mantle cell lymphoma (cyclin D1 activation)

103
Q

t(11,18)

A

Marginal cell lumphoma

104
Q

t(14,18)

A

Follicular lymphoma (BCL-2 activation)

105
Q

t(15,17)

A

M3 AML (APL acute promyelogenic leukemia)
Responds to All trans retinoic acid

106
Q

Down syndrome associated with?

A

AML

107
Q

Birbeck granules

A

Langerhans cell histocytosis
Express s100, CD1a

ASU Yr4 Flashcards (6 decks)

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